x
這系列的第一集，我們講解了PD1/PDL1的運作原理。685Please respect copyright.ＰＥＮＡＮＡasnnFwbFHT
Link: https://www.penana.com/article/471125685Please respect copyright.ＰＥＮＡＮＡc3aVRNY5Cg
685Please respect copyright.ＰＥＮＡＮＡt9Qiu0oGuv
第二集我們講述CTLA4與T cell功用的關係。685Please respect copyright.ＰＥＮＡＮＡIgMZ9UmI2o
Link:https://www.penana.com/article/472480685Please respect copyright.ＰＥＮＡＮＡZhrNynlSf4
685Please respect copyright.ＰＥＮＡＮＡH4JD7nVwLO
第三集我們講述增加T cell順利到達癌細胞位置的其中一種手段。685Please respect copyright.ＰＥＮＡＮＡakirEDW4FB
https://www.penana.com/article/479229685Please respect copyright.ＰＥＮＡＮＡa9xku5AcL2
685Please respect copyright.ＰＥＮＡＮＡUm6DxUWHqq
而這一集我們將講解一道關於檢測阻擋PD1的抗體Pembrolizumab成效的研究。685Please respect copyright.ＰＥＮＡＮＡbPADVrYELW
685Please respect copyright.ＰＥＮＡＮＡezAL0vx4TH
685Please respect copyright.ＰＥＮＡＮＡLPnrHyPrqx
關於阻檔PD1的原理及初心，可參閱第一集，其後可直接跳過第二第三集來到第四集本集。685Please respect copyright.ＰＥＮＡＮＡRf4Bu6XeyE
685Please respect copyright.ＰＥＮＡＮＡERH8SN5X9g
685Please respect copyright.ＰＥＮＡＮＡoXED7IHVvw
685Please respect copyright.ＰＥＮＡＮＡESe3jT7uhZ
（圖2）現今約只有20%的病人能夠從免疫治療中獲取長遠且持續的正面效果。685Please respect copyright.ＰＥＮＡＮＡTIfXrbutw9
685Please respect copyright.ＰＥＮＡＮＡTZtHug4U1i
685Please respect copyright.ＰＥＮＡＮＡ8EzhtRLW1L
其有效的程度實屬可圈可點，如果有方法能夠盡快得知免疫治療沒有預期成效的話，那就可以即時轉用其他治療手段，把握時候嘗試用第二種方法入手打擊癌症。685Please respect copyright.ＰＥＮＡＮＡjvs0uAmA1Z
685Please respect copyright.ＰＥＮＡＮＡ5d0aI7c9Ne
對此，有科學家嘗試量度血液中癌細胞的DNA含量，觀察能否藉此方法預判免疫治療的效果（Ref1)。685Please respect copyright.ＰＥＮＡＮＡntxbik7uNr
685Please respect copyright.ＰＥＮＡＮＡUQeYB8eyjJ
685Please respect copyright.ＰＥＮＡＮＡNrt4wfJdzb
(圖3）癌細胞DNA之所以會出現在血液中，主要由兩大途徑所成。685Please respect copyright.ＰＥＮＡＮＡMldU2vbeo3
685Please respect copyright.ＰＥＮＡＮＡ8UX22L7bpQ
685Please respect copyright.ＰＥＮＡＮＡfQMihpPhZT
1.癌細胞會利用血液循環系統或者淋巴系統轉移到第二個位置，685Please respect copyright.ＰＥＮＡＮＡhuckTEbA5A
因此血液會有癌細胞的DNA。685Please respect copyright.ＰＥＮＡＮＡ1CLzFIKFYB
685Please respect copyright.ＰＥＮＡＮＡVwxhVDhFk2
2.癌細胞亦會往外釋出名Exosome的物質，裡頭亦含有癌細胞的DNA。685Please respect copyright.ＰＥＮＡＮＡyhebIqvC4d
685Please respect copyright.ＰＥＮＡＮＡeGQXE3AFnB
在這裡，我們暫稱癌細胞在血液中的DNA為ctDNA，Circulating Tumor DNA。685Please respect copyright.ＰＥＮＡＮＡ0VISNnyea1
685Please respect copyright.ＰＥＮＡＮＡRgOza29bpV
（圖4）圖中為利用阻擋PD1的抗體Pembrolizumab作治療的兩名病人結果。685Please respect copyright.ＰＥＮＡＮＡrX75HjLEqb
685Please respect copyright.ＰＥＮＡＮＡXrylTVL7Nf
685Please respect copyright.ＰＥＮＡＮＡxzZcimVHU4
紅線為電腦斷層掃描觀察癌細胞大小的影像，而黑線為量度癌細胞在血液(ctDNA)的含量，可見黑線(量度ctDNA的含量)能夠更快預判免疫治療結果成效。685Please respect copyright.ＰＥＮＡＮＡlKSnAUZ60c
685Please respect copyright.ＰＥＮＡＮＡhBv3pdeBeS
而且，有另外10名接受免疫治療的病人在初期(服用藥物後6-7星期)錄得ctDNA完全下降，亦同樣能夠比電腦斷層掃描觀察更早一步預判成效。685Please respect copyright.ＰＥＮＡＮＡOKpqHW5Gjc
685Please respect copyright.ＰＥＮＡＮＡLq0qLyH03I
而研究中有45名免疫治療的病人在初期沒有錄得任何的ctDNA跌幅，癌細胞的體積在其後亦沒有明顯縮細。685Please respect copyright.ＰＥＮＡＮＡDWJfBD8vys
685Please respect copyright.ＰＥＮＡＮＡgvmBqjwYc5
685Please respect copyright.ＰＥＮＡＮＡN4clPk8XZb
對比含放射性的電腦斷層掃描，量度血液的ctDNA只需抽取病人的血液便可，明顯簡單且快捷。685Please respect copyright.ＰＥＮＡＮＡqMrTq0mt3w
只不過每名病人的ctDNA排組均不一樣，先前需要拿取部份癌細胞組織，才能夠有效設計檢測ctDNA的方針。685Please respect copyright.ＰＥＮＡＮＡdBdUT2Vcp8
685Please respect copyright.ＰＥＮＡＮＡjpp5etKSSL
無論如何，若然日後能有研究進一步確立此方法的成效及可信性，定必大可增加對抗癌症的效益。685Please respect copyright.ＰＥＮＡＮＡ8E74AD70Ax
685Please respect copyright.ＰＥＮＡＮＡPBuB6j4Ot0
另一方面，透過檢測血液的DNA來預先得知癌細胞的存在，亦是日後檢驗及預防癌症的主流大方向。685Please respect copyright.ＰＥＮＡＮＡdPWUj3JbZY
685Please respect copyright.ＰＥＮＡＮＡJfCgvsFP4n
如果想我快啲出文的話，請入去Penana網站科普專欄–薯不揀單俾一個like以及Bookmark，這對我非常之重要。685Please respect copyright.ＰＥＮＡＮＡxLah9gX8Zh
685Please respect copyright.ＰＥＮＡＮＡftkbNcyQVo
Link: https://www.penana.com/story/66244/%E7%A7%91%E6%99%AE%E5%B0%88%E6%AC%84-%E8%96%AF%E4%B8%8D%E6%8F%80%E5%96%AE/toc685Please respect copyright.ＰＥＮＡＮＡdFFV7EiAXi
685Please respect copyright.ＰＥＮＡＮＡEW9dU3Abc4
同時亦可以在Penana網站裡按「買一嚿/半嚿薯仔」，以課金的方式推動我繼續搜羅資料寫文，多謝。685Please respect copyright.ＰＥＮＡＮＡRoWACbdrFL
685Please respect copyright.ＰＥＮＡＮＡtq1G0tEe9b
Link:685Please respect copyright.ＰＥＮＡＮＡsOL26WTmgj
https://www.penana.com/user/27349/%E8%96%AF%E4%BB%94%E8%81%9E%E8%8C%B1%E8%8E%89/portfolio685Please respect copyright.ＰＥＮＡＮＡxEKslPNOHT
685Please respect copyright.ＰＥＮＡＮＡqvgcYRpkP2
685Please respect copyright.ＰＥＮＡＮＡz0TppuAXAk
有興趣接收科學資訊的話，歡迎follow IG: potatopigtongue。685Please respect copyright.ＰＥＮＡＮＡoblB8XwMPL
685Please respect copyright.ＰＥＮＡＮＡKn9QEYbUVP
https://www.instagram.com/potatopigtongue/685Please respect copyright.ＰＥＮＡＮＡ4cLZhkamrH
685Please respect copyright.ＰＥＮＡＮＡPkqFJ1U1zL
685Please respect copyright.ＰＥＮＡＮＡCtOgAT0bQR
Ref1:https://www.nature.com/articles/s43018-020-009685Please respect copyright.ＰＥＮＡＮＡnZsQjfYSUg
